Email:_______________________________________________
I hereby certify that the work submitted to the Phoenix Public Library was created
by me and is completely original.

___________________________________
Signature

___________
Date

This release form must be signed by the parent or legal guardian of
participants under 18 years of age.

FOR PARENT OR GUARDIAN:
I hereby grant the right to use the participantâ&#x20AC;&#x2122;s name, creative works, and visual
image on the Phoenix Public Library or City of Phoenix website, in printed form
as part of Create!Zine, and/or for library promotion, without recourse. This
includes rights to use creative works produced by the participant in promotional,
documentary or media coverage for promoting Phoenix Public Library programs.
This release grants the Phoenix Public Library the right to use the name and
likeness of the participant and/or creative works produced by the participant on
the Library or City of Phoenix website, in printed form as part of Create!Zine,
and/or for library promotion.
____________________________________________
Signature of parent or guardian